SS Part A July 19 2011

SS Part A July 19 2011.doc

Formative Research for and Community Uptake of the Eagle Books and Youth Books for American Indians and Alaska Natives

OMB: 0920-0897

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formative research FOR and community uptake of the Eagle Books and youth books for American Indians and Alaska Natives







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Supporting Statement: Part A



July 19, 2011






Submitted by:

Division of Diabetes Translation

National Center for Chronic Disease Prevention and Health Promotion

Centers for Disease Control and Prevention

Atlanta, Georgia


Lemyra DeBruyn, PhD

Telephone: 505.232.9906

Email: [email protected]


Dawn Satterfield, PhD

Telephone: 770.488.5285

Email: [email protected]










Table of Contents



Part A: Justification

A1. Circumstances Making the Collection of Information Necessary

A2. Purpose and Use of Information Collection

A3. Use of Improved Information Technology and Burden Reduction

A4. Efforts to Identify Duplication and Use of Similar Information

A5. Impact on Small Businesses or Other Entities

A6. Consequences of Collecting the Information Less Frequently

A7. Special Circumstances Relating to the Guidelines of 5 CFR 1320.5

A8. Comments in Response to the Federal Register Notice and Efforts to Consult Outside the Agency

A9. Explanation of Any Payment or Gift to Respondents

A10. Assurance of Confidentiality Provided to Respondents

A11. Justification for Sensitive Questions

A12. Estimates of Annualized Burden Hours and Costs

A12-1.Estimated Annualized Burden Hours

A12-2.Cost to Respondents

A13. Estimates of Other Total Annual Cost Burden to Respondents or Record Keepers

A14. Annualized Cost to the Federal Government

A15. Explanation for Program Changes or Adjustments

A16. Plans for Tabulation and Publication and Project Time Schedule

A17. Reason(s) Display of OMB Expiration Date is Inappropriate

A18. Exceptions to Certification for Paperwork Reduction Act



Attachments


A-1. Authorizing Legislation: PHSA

A-2. Authorizing Legislation: WIC

B-1. Federal Register Notice

B-2. Summary of Public Comments and CDC Response

C-1. Community Representatives Interview Guide

C-2. Community Representatives Information Sheet

C-3. Community Representatives Consent Form

D-1. School Administrators Interview Guide

D-2. School Administrators Information Sheet

D-3. School Administrators Consent Form

E-1. Teachers Discussion Guide

E-2. Teachers Information Sheet

E-3. Teachers Consent Form

F-1. Parents Discussion Guide

F-2. Parents Information Sheet

F-3. Parents Consent Form

G-1. Children Grades K-1 Discussion Guide

G-2. Children Grades K-4 Parental Consent

G-3. Children Grades K-4 Youth Assent

H-1. Children Grades 2-3-4 Discussion Guide

H-2. Children Grades K-4 Parental Consent

H-3. Children Grades K-4 Youth Assent

I-1. Middle Schooler Youth Books Discussion Guide

I-2. Middle Schooler Parent Information Sheet

I-3. Middle Schooler Parental Consent

I-4. Middle Schooler Youth Assent

J. IRB Approval

K. Site Visit Scheduling Worksheet

L. Observation Checklist



A. Justification


1. Circumstances Making the Collection of Information Necessary


Background


Although rare in American Indian and Alaska Native (AI/AN) communities 60 years ago, diabetes is now part of the fabric of losses in many tribal communities. From 1994 to 2004, the age-adjusted prevalence of diagnosed diabetes more than doubled among American Indians and Alaska Natives aged 35 years or younger who use Indian Health Service (IHS) health care services (CDC, 2006). Because they develop type 2 diabetes at younger ages, experience more years of disease burden, and have a high probability of developing diabetes-related complications (Roberts, 2009; Harris, 1995), effective diabetes prevention programs targeting American Indian and Alaska Native youth are a compelling priority in education and public health.


The Centers for Disease Control and Prevention’s (CDC) Native Diabetes Wellness Program (NDWP) works with a growing circle of partners committed to addressing the health inequities so starkly revealed by diabetes in Indian Country. The program strives to:


  • Share messages, including stories and art, about traditional ways of health that are remembered, retold, and talked about in homes, schools, and communities.

  • Support sustainable, evaluable ecological approaches to promote the use of traditional foods in American Indian and Alaska Native communities.

  • Support meaningful tribal consultation at state and federal levels.


Tribal consultation and feedback from tribal communities have guided NDWP in respecting traditional knowledge and practices to promote health and prevent illness. A school-based education curriculum and a series of diabetes prevention and control print materials have been developed specifically for AI/AN communities.

The Eagle Books. In collaboration with Indian Health Service’s (IHS) Division of Diabetes Treatment and Prevention, NDWP consulted with the IHS Tribal Leaders Diabetes Committee and listened carefully to input from over 400 tribal representatives who advised NDWP to reach children, as first priority, through stories. Inspired by the wisdom of traditional ways of health in tribal communities, the Eagle Books were created in 2005, under contract with Westat, a research corporation. The stories of a wise eagle, grateful rabbit, clever coyote and four young friends are introduced in the four-book series (Through the Eyes of the Eagle, Knees Lifted High, Plate Full of Color, and Tricky Treats). The books were written by Georgia Perez, a community health representative for 19 years in Nambe Pueblo, New Mexico, and illustrated by Patrick Rolo (Bad River Band of Ojibwe, Wisconsin) and Lisa A. Fifield (Oneida Tribe of Wisconsin, Black Bear Clan). The books embrace the joy of being physically active, eating healthy foods, learning from elders about health, and preventing type 2 diabetes in Indian Country. Almost 3 million copies of the Eagle Books have been distributed.



In addition to being widely distributed on their own, the Eagle Books have also been incorporated into the lesson plans for the Kindergarten (K) through fourth grades of the NIH Diabetes Education in Tribal Schools (DETS) curriculum, Health is Life in Balance.

The Youth Books. In 2007, NDWP developed three new Eagle Books (Youth Books) for Native American youth ages nine to thirteen. The first book (Coyote and the Turtle’s Dream) uses the same characters featured in the original Eagle Book series and introduces new human and animal characters. Youth Books 2 and 3 (Hummingbird’s Squash and The Trickster of Two Rabbit Mountain), will follow the same pattern. A four volume graphic novel will accompany the first Youth Book (Coyote and the Turtle’s Dream). Two follow-up comic books are also planned, one for Youth Book 1 (Coyote and the Turtle’s Dream) and one for Youth Book 2 (Hummingbird’s Squash). These graphic novel and comic books are designed to broaden the literacy capacity for story outreach, as well as feature high-action sequences and superhero figures to attract boys ages 11 to 13. All three Youth books will focus on healthy foods, physical activity, community and family, social support, and Native American history and science. The books will be accompanied by a curriculum guide and ancillary products, such as play scripts.

Communication and Outreach. In 2008, NDWP began implementing a range of communication and outreach activities designed to promote the original four Eagle Books. These activities have included development of an Eagle Books website, presentations at national conferences, CDC TV programming, video development, and Talking Circles. In addition, NDWP has made targeted communication and outreach investments in selected AI/AN communities. Activities in these communities have included exhibits, health fairs, storytelling activities, Talking Circles, presentations at PowWows, tribal museums, local colleges, etc. NDWP has also supported onsite, ongoing Eagle Books promotion activities (delivered by health educators and/or diabetes prevention advocates), as well as DETS curriculum activities that promoted the Eagle Books. To date, NDWP has invested over $400,000 developing and implementing these targeted communication and outreach activities and over 10,000 people have been reached.


Currently, NDWP is developing a new Eagle Books website that will host the full range of Eagle Books and Youth Books products and ancillary materials (e.g., the Books themselves, posters, stickers, coloring books, and educational products). The site will also feature a range of promotional and outreach materials AI/AN communities can use to develop and launch their own diabetes prevention efforts. The site will contain instructional videos for developing and hosting health fairs, Talking Circles, and school-based events. The site will also provide users with access to all Eagle Books graphics materials, many of which can be customized for local community use to promote health messages and events. These include posters, graphics for all Eagle Books characters and book themes, and curriculum guides for use by teachers and/or health educators.

Justification

As stated, NDWP has made a considerable investment in the development, distribution, and promotion of the original Eagle Books. In addition, demand for the original books remains high and interest in and demand for the new Youth Books are significant. However, only anecdotal information is known about audience satisfaction with, receptivity to, or influence of the Eagle Books in the AI/AN community. Similarly, aside from distribution data, NDWP has only anecdotal information regarding the effectiveness of its efforts to market and promote the Eagle Books, particularly in the selected “high dose” communities. Given that NDWP will no longer be able to maintain or expand its current communication and outreach efforts for the original Eagle Books and will have fewer resources to devote to promoting the upcoming Youth Books, it is critical that NDWP learns more about which communication and outreach activities have been well received and which best support community uptake. As standard practice in marketing and communication, it is important for NDWP to conduct formative research on the new Youth Books to ensure their saliency and relevance to the target audience (i.e., middle schoolers).


To this end, NDWP is requesting OMB approval to 1) assess audience (i.e., children, parents, schools, and community representatives) satisfaction with and receptivity of the Eagle Books in selected AI/AN communities that have received and used the books in school and community settings; 2) assess and compare the degree of community uptake or market penetration of the Eagle Books, as well as the influence of the Books on type 2 diabetes prevention efforts, in “high dose” AI/AN communities and communities in which there has been “independent uptake” of the Eagle Books, without support from CDC; and 3) gather input and feedback from middle schoolers on draft versions of the final two Youth Books (i.e., Hummingbird’s Squash and The Trickster of Two Rabbit Mountain). These books are currently under development.


Findings from this data collection will prove useful in several ways. First, information gathered regarding the degree of community uptake of the Eagle Books will provide valuable feedback about the effect of NDWP’s marketing and promotion efforts in “high dose” communities. Specifically, NDWP will be able to determine what marketing and promotion strategies and products have proven successful, which are less effective, and to what extent these efforts have been sustained. Additionally, information gathered from comparison communities (those that did not receive external NDWP outreach and marketing support), will help NDWP determine what local or non-CDC resources are available to communities and how these might be leveraged to support uptake of the Eagle Books with limited or no CDC support. As NDWP begins to move most of its marketing and promotion efforts to the new website, learning more about how NDWP can support AI/AN communities to independently use and promote the Eagle Books and their health messages will be very important. If more funds become available to support onsite promotional activities, findings from this data collection will also help NDWP determine which onsite promotional activities are worthy of investment.


Second, (as previously discussed), the Eagle Books have also been incorporated into the Kindergarten through 4th grade lesson plans of the DETS curriculum. Despite the substantial investment CDC has made to incorporate Eagle Books into the DETS curriculum, little is known about how the DETS curriculum has advanced or supported the messages of the Eagle Books. Thus, the proposed data collection will also gather feedback from schools that use the DETS curriculum on how DETS has supported the Eagle Books messages and in turn, how the Eagle Books have supported the DETS curriculum. This feedback help determine if CDC should explore opportunities for incorporating the Youth Books into the DETS 5th through 8th grade curriculum.


Third, NDWP will receive valuable feedback about how AI/AN communities respond to and what they think of the use of traditional stories, characters, art work, and themes to impart type 2 diabetes prevention messages. This feedback will be used not only to shape the content and direction of the proposed Youth Books, but to help determine if CDC or other health agencies can successfully apply storytelling techniques and traditional characters and themes to address other public health problems facing AI/AN communities.


Finally, feedback gathered from middle schoolers regarding Youth Books 2 and 3 will be used to support revisions of the Books to ensure their appeal, saliency, relevance, and cultural competency to the middle school audience.


Authorization to collect this information is contained in the Public Health Service Act (42 U.S.C. § 241) Section 301 (see Attachment A-1). Authorization is also found in Sections 204(b)(1) and (2) of Public Law 108-265, the 2004 Child Nutrition and WIC Reauthorization Act (Attachment A-2, extended to September 30, 2010, and reauthorized in the Healthy, Hunger-Free Kids Act of 2010, S. 3307, Section 423).


Privacy Impact Assessment Information


No sensitive information is being collected and the proposed data collection will have little or no effect on the respondent’s privacy. Identifying information will only be collected by local scheduling facilitators and used solely for the purposes of scheduling interviews and focus groups. No information in identifiable form will be linked to participant responses.


Overview of the Data Collection System


Information will be collected using qualitative, case study methodology in eight selected AI/AN communities that currently use the Eagle Books: four communities that received onsite communication and outreach support from NDWP and NIH-supported contractors promoting the DETS curriculum and the accompanying Eagle Books (i.e., “high dose” communities) and four communities that have independently adopted and used the Eagle Books without external NDWP support (i.e. “independent uptake” communities).


Data collection will involve focus groups and in-depth interveiws conducted during site visits to eight selected AI/AN communities over a two-year period. Each site visit will involve the following data collection activities:


  • Interviews with up to three community health representatives (e.g., health department representatives, community health workers, tribal council members, representatives from the Indian Health Service).

  • Interviews with one school administrator (e.g., school principals) from a local elementary school

  • One discussion (focus) group with K-4 teachers from a local elementary school

  • Two discussion (focus) groups with parents: one group with parents of younger children (kindergarten and first grade) one group with parents of older children (second, third, and fourth graders).

  • Two discussion (focus) groups with children: one group with younger children (kindergarten and first grade) and one group with older children (second, third, and fourth graders).

  • Observational tours of the community (e.g., school building and grounds, health clinics, recreation centers, community gathering spaces, local businesses, etc.).

  • Two discussion (focus groups) with middle schoolers (conducted in only four of the eight communities) to gather feedback on draft versions of Youth Books 2 and 3.

Items of Information to be Collected


The proposed information collection is designed to answer the following research questions:


  1. Are traditional stories, themes, and characters a viable health communication method for diabetes prevention in AI/AN communities? (i.e., Are they well received in AI/AN communities?)

  2. How have the Eagle Books influenced physical activity and nutrition related knowledge, attitudes, and behaviors in AI/AN communities?

  3. How have the Eagle Books supported existing, local diabetes prevention efforts?

  4. What marketing and promotion channels/activities have worked best to support community uptake of the Eagle Books?

  5. What factors support independent uptake of the Eagle Books and Youth Books?

  6. How are the draft Youth Books received among middle school audiences?


During the site visits, all respondents will be asked questions to assess their overall awareness of the Eagle Books and to provide general feedback about the Eagle Books, including their thoughts about the characters, content, and format. All respondents will also be asked questions to ascertain their level of exposure to diabetes prevention efforts in their communities, including any communication and outreach activities conducted or supported by NDWP.


Children and parents will be asked questions to determine how the Eagle Books have influenced knowledge, attitudes, and behaviors with regards to diabetes prevention. Teachers and school administrators will be asked to discuss any efforts they have made to adopt or incorporate the Eagle Books, and their health messages, into educational activities in the school setting.


Community representatives (e.g., staff at local Indian Health clinics, diabetes educators, tribal council members, etc.) will be asked to discuss local diabetes prevention efforts and how Eagle Books have supported these efforts. Observational tours of schools and communities will provide information about the extent to which Eagle Books messages and ancillary products are disseminated (see Attachment L).


Neither CDC nor Westat will collect information in identifiable form (IIF). The identifiable information necessary to schedule the interviews will be retained by the local scheudling facilitator.


Identification of Website and Website Content Directed at Children Under 13 Years of Age


This data collection does not involve web-based data collection, does not host a website, and does not refer respondents to websites.


2. Purpose and Use of Information Collection


The purpose of this information collection is to 1) assess audience (i.e., children, parents, schools, and community representatives) satisfaction with and receptivity towards the Eagle Books in selected AI/AN communities that have received and used the books in school and community settings; 2) assess and compare the degree of community uptake or market penetration of the Eagle Books, as well as the influence of the Books on diabetes prevention efforts, in “high dose” AI/AN communities and communities that took up the Eagle Books on their own; and 3) gather input and feedback from middle schoolers on draft versions of the final two Youth Books in the Eagle Books series (i.e., Hummingbird’s Squash and The Trickster of Two Rabbit Mountain). These books are currently under development.


As previously discussed, findings from this data collection will prove useful in a number of ways. Information gathered regarding community uptake (in both “high dose” and “independent” communities) will help NDWP determine what marketing and promotion strategies and products merit further support or investment. Additionally, information gathered from the “independent uptake” will help NDWP determine how local or non-CDC resources might be leveraged to support uptake of the Eagle Books in the face of limited onsite promotional support.


Because the Eagle Books have also been incorporated into the K-4 portion of the DETS curriculum, feedback gathered from school personnel who have used the DETS curriculum will help determine if NDWP should explore opportunities for incorporating the Youth Books into the DETS 5th through 8th grade curriculum.


This data collection will also provide valuable feedback about what AI/AN communities think of the use of traditional stories, characters, art work, and themes to impart type 2 diabetes prevention messages. This feedback will be used to shape the content and direction of the proposed Youth Books and may help determine if traditional storytelling techniques, characters, and themes are a viable option for addressing other public health problems facing AI/AN communities. Finally, testing of draft versions of Youth Books 2 and 3 will support revisions of the Books to ensure their appeal, saliency, relevance, and cultural competency to the middle school audience.

Overall, the proposed data collection allows for an indepth, in situ assessment of AI/AN audience satisfaction, receptivity, influence, and meaning of the Eagle Books. Findings from this data collection will help NDWP more effectively promote independent uptake and support sustainability of Eagle Books health messages.

Privacy Impact Assessment


No sensitive information is being collected and the proposed data collection will have little or no effect on the respondent’s privacy. Identifying information will be collected by local scheduling facilitators only and will be used solely for the purposes of recruiting participants and scheduling interviews and focus groups. No information in identifiable form will be linked to participant responses.


3. Use of Improved Information Technology and Burden Reduction


Given that fact that respondents live in remote areas of the country with limited access to computers or the Internet, using electronic information technology to support data collection is not feasible. In-person interviews and focus groups will be used to collect data. In-person data collection is also more appropriate for children and is in keeping with target audiences’ preferences.


4. Efforts to Identify Duplication and Use of Similar Information


This data collection effort aims to gather community feedback about the Eagle Books and related promotional efforts. Aside from anecdotal information shared by AI/AN communities and partner agencies, NDWP has no information on how the Eagle Books have been received, the influence of the Books, or the effects of onsite communication and outreach efforts. No other agency or organization has gathered this information. The information to be collected is not available from other sources.


5. Impact on Small Businesses or Other Small Entities


There is no burden on small businesses or small entities and no small businesses will be involved in this effort. Respondents will voluntarily participate in interviews or focus groups and every effort has been made to keep the number of questions at the minimum required to meet project objectives.


6. Consequences of Collecting the Information Less Frequently


Respondents are residents of and/or work in the eight AI/AN communities selected for this project. Each site will be visited only once during the course of the project, thus this is a one-time request.


The Eagle Books represent a set of unique diabetes-related communication products developed specifically for AI/AN audiences. Without this information, NDWP will not be able to incorporate the experiences and perspectives of AI/AN audiences into its efforts to sustain Eagle Books messages or improve and promote independent uptake of the Eagle Books in more AI/AN communities. Specifically, NDWP will not be able to determine if the original Eagle Books are well received in AI/AN communities, if they are having any influence, if current communication and outreach activities are having any effect, and if draft versions of Youth Books 2 and 3 will resonate with middle school audiences. Additionally, NDWP will have limited capacity to make informed, culturally appropriate decisions about which Eagle Books promotional products and strategies should be further supported. There are no legal obstacles to reducing the burden.


7. Special Circumstances Relating to the Guidelines of 5 CFR 1320.5


There are no special circumstances with this information collection request. This request fully complies with the guidelines of 5 CFR 1320.5.


8. Comments in Response to the Federal Register Notice and Efforts to Consult Outside the Agency


A. A 60-day Notice was published in the Federal Register on February 11, 2011 (Vol. 76, No. 29, pp. 7856-7858, see Attachment B-1). One public comment was received and acknowledged (see Attachment B-2).


  1. NDWP has worked closely with Westat (the contractor), and several consultants (Dr. Carolee Dodge-Francis, L. Carson Henderson, and Dr. Lynn Aho) on the overall project design as well as the development of all data collection instruments. Dr. Dodge-Francis is Executive Director of the American Indian Research and Education Center at the University of Nevada, Las Vegas and currently trains teachers in implementing the DETS curriculum in Nevada and other states. L. Carson Henderson is Associate Professor of Research and Project Coordinator at the American Indian Diabetes Prevention Center at the University of Oklahoma Health Sciences Center. Dr. Aho is a researcher at the Keweenaw Bay Ojibwa Community College. Dr. Dodge-Francis, Ms. Henderson, and Dr. Aho have reviewed the data collection instruments to ensure that the content, wording, format, overall flow/ordering of questions, and timing are appropriate. Westat staff have extensive experience with the Eagle Books. Under contract to NDWP, Westat has overseen the development of the original Eagle Books and are presently developing the Youth Books as well as the Eagle Books website and all promotional materials.


9. Explanation of Any Payment or Gift to Respondents


Parents will receive $70 for participating in the discussion (focus) groups. This amount has been the standard and usual level of reimbursement for audiences in similar CDC funded activities. This amount was also determined based on 1) the time commitment and effort asked of parents in relation to the average hourly rate of US workers; 2) the cost of child care for children not participating in the focus groups; and 3) the fact that data will be collected from parents as well as their child. Further, the $70 will also help defray transportation costs associated with attending the focus groups. The AI/AN communities that will be visited are located in remote areas. In many cases, residents travel anywhere from 10 to 20 miles to reach a town center or other community resources.


Parents of middle schoolers participating in the discussion groups to test the draft Youth Books will receive $35. This amount was determined based on the time commitment and effort asked of parents in relation to the average hourly rate of US workers. The $35 is also intended to help defray transportation costs associated with bringing their children to the focus groups. Children participating in the groups will receive a free set of Eagle Books materials and promotional products.


School administrators and teachers, as state or local government employees, are typically not allowed to receive incentive payments, gifts, or honoraria for activities considered to be part of their official duties or job. Thus, at this time we do not plan to provide any payment or gift directly to these respondents. We do plan to conduct interviews and focus groups on school premises, preferably before school begins, during lunch, or after students are dismissed, so as to minimize transportation burden for school staff. NDWP will also provide participating schools with a set of Eagle Books materials and promotional products.


Given that community health representatives are often employed by local, state, or Federal government agencies, we anticipate that these respondents will likely be ineligible for any payments or gifts for their participation. Thus, NDWP will provide respondents with free copies of Eagle Books materials and promotional products. In the event that a community health representative is employed in the private sector, a $70 cash payment will be provided.


10. Assurance of Confidentiality Provided to Respondents


IRB approval has been obtained from the data collection contractor’s IRB. A copy of the most recently approved amendment is included as Attachment J.


  1. Privacy Act Determination. Staff in the CDC Information Collection Review Office have reviewed this Information Collection Request and have determined that the Privacy Act is not applicable. Although local community contacts will have access to respondents’ names in order to schedule interviews and discussion groups, respondent names will not be provided to the NDWP or the evaluation contractor, Westat. Westat will work closely with local scheduling facilitators to recruit respondents for the interviews and focus groups. Local scheduling facilitators will submit to Westat the completed scheduling worksheets they have used to verify eligibility and schedule participants. However, these worksheets will only provide Westat with a summary of participant information and will not include any identifying information (name, address, telephone number, e-mail address, etc.). This information will be gathered solely for scheduling purposes and to make confirmation/reminder calls. The local recruiting contact will be instructed to destroy their project-related records at the conclusion of the project. The information to be collected is not sensitive. No information in identifiable form will be linked to participant responses.


  1. Safeguards. The data collected will not contain any personal identifiers and will be stored at Westat on secure share drive and password-protected computers. The information respondents provide during interviews and discussion groups will not be linked to the respondents’ identities. Respondents will use only first names or pseudonyms during the group discussions. Notes will not include respondents’ names and will be stored at Westat on secure share drive and password-protected computers. Reports will not include any identifiable information. Site visitors not employed by CDC or Westat, as well as the local scheduling facilitator, will be required to sign a non-disclosure agreement. Names or other personal identifiers will not be linked to any data that are reported. Data will be reported in the aggregate, summarized by type of respondents or respondent categories (e.g., school staff, parents, and children) and not by individual.

  1. Consent. Consent will be obtained from adult respondents who are community representatives, administrators, teachers, or parents (see Attachments C-3, D-3, E-3, and F-3, respectively). For respondents who are children, parental consent will be obtained (see Attachments G-2, H-2, and I-3) as well as the assent of the child (see Attachment G-3, H-3, and I-4). The consent forms will describe the uses of the information collection, and safeguards for respondents.


  1. Nature of Response. Participation in this effort is completely voluntary. Respondents will be informed via local community contacts that NDWP would like them to participate in a discussion (focus) group or interview regarding the Eagle Books and DETS. Informational sheets (see Attachments C-2, D-2, E-2, F-2, and I-2) will be sent to local scheduling facilitators for distribution to respondents. The informational sheets provided to respondents will clearly state that the interviews and discussion groups are voluntary, describe safeguards, and describe the intended uses of the information collected.


11. Justification for Sensitive Questions


None of the data collection instruments contain questions that could be considered sensitive such as questions about sexual behavior and attitudes, religious beliefs, or alcohol or drug use. If a respondent finds any question to be objectionable, the respondent may choose to not answer that question. The option to skip or not answer any question will be explained at the start of each interview or focus group and is clearly stated in the consent forms.


12. Estimates of Annualized Burden Hours and Costs


  1. Estimated Annualized Burden Hours


Information will be collected in eight communities over a two-year period. On average, information collection will occur in four communities per year, with the exception of the discussion groups for middle school students, which will be conducted in only two communities per year. The total estimated annualized burden is 112 hours, for activities itemized below.


  • Verification and scheduling of respondents by 4 local scheduling facilitators (one per community, see Attachment K). The annualized burden hours are 12.

  • Interviews of one hour will be conducted with 12 community health representatives (three in each community; see Attachment C-1, Community Representatives Interview Guide). An Information Sheet for Community Representatives (Attachment C-2) will be provided to each respondent. The annualized burden hours are 12.

  • Interviews of one hour will be conducted with 4 local elementary school administrators, one administrator per community (see Attachment D-1). The annualized burden hours are 4.

  • Discussion groups of 1.25 hours will be conducted with 16 local school teachers (grades K-4), four teachers per community (see Attachment E-1). The annualized burden hours are 20.

  • Discussion groups of one hour will be conducted with 32 parents (8 parents per community, in groups of 4). One discussion group will be conducted with 4 parents of children in grades K-1 and one discussion group will be conducted with 4 parents of children in grades 2-4. The same discussion guide will be used for both groups, although the groups will be segmented (see Attachment F-1). The annualized burden hours are 32.

  • Discussion groups of 45 minutes will be conducted with 32 children (8 children per community, in groups of four). One discussion group will be conducted with four children in Kindergarten and first grade (see Attachment G-1) and one discussion group will be conducted with four children in second, third, and fourth grades (see Attachment H-1). The annualized burden hours are 24.

  • Discussion groups of one hour will be conducted with 8 middle school aged-children (4 children in 2 communities, 4 children per group) (see Attachment I-1). The annualized burden hours are 8.

For information collection in four communities per year, the total annualized burden hours are 112. The observation checklist (see Attachment L) will be completed by project staff only and not require any input or data collection from respondents.


Table A.12-A. Estimated Annualized Burden Hours (4 site visits per year)


Type of Respondent

Form Name

Number of Respondents

Number of Responses per Respondent

Average Burden per Response (in hours)

Total Burden (in hours)

Local Scheduling Facilitators

Scheduling Worksheet

4

1

3

12

Community Representatives

Community Representatives Interview Guide

12

1

1

12

School Administrators

School Administrators Interview Guide

4

1

1

4

Teachers

Teachers Discussion Guide

16

1

75/60

20

Parents

Parents Discussion Guide

32

1

1

32

Children

Children Grades K-1 Discussion Guide

16

1

45/60

12

Children Grades 2-4 Discussion Guide

16

1

45/60

12

Middle Schoolers Discussion Guide

8

1

1

8

Total

108

Total

112


  1. Estimated Annualized Cost to Respondents


The average hourly wage for community health representatives is based on data from the May 2008 Bureau of Labor Statistics National Occupational Employment and Wage Estimates for Community and Social Service Occupations, which includes occupations such as medical and public health social workers, health educators, and community and social services specialists. The average hourly rate for all other teachers and school administrators is based on data from the May 2008 Bureau of Labor Statistics National Occupational Employment and Wage Estimates. The average hourly rate for local scheduling facilitators and parents is based on the March 2010 average hourly earnings for all employees of private nonfarm payrolls as reported by the Bureau of Labor Statistics. The total annualized cost to respondents is $1,897.


Table A.12-B. Annualized Cost to Respondents

Type of Respondent

Form Name

Number of Respondents

Total Burden (in hours)

Average Hourly Wage

Total Cost

Local Scheduling Facilitator

Scheduling Worksheet

4

12

$22.47

$270

Community Representatives

Community Representatives Interview Guide

12

12

$20.09

$241

School Administrators

School Administrators Interview Guide

4

4

$41.37

$165

Teachers

Teachers Discussion Guide

16

20

$25.11

$502

Parents

Parents Discussion Guide

32

32

$22.47

$719

Children

Children Grades K-1 Discussion Guide

16

12

$0

$0

Children Grades 2-4 Discussion Guide

16

12

$0

$0

Middle Schoolers Discussion Guide

8

8

$0

$0


Total

$1,897


13. Estimates of Other Total Annual Cost Burden to Respondents or Record Keepers


There are no additional costs to the respondents.


14. Annualized Cost to the Federal Government


Design of the data collection instruments, scheduling of site visits, conduct of interviews and focus groups, and analysis of data will be conducted by NDWP’s contractor, Westat, with additional support provided by Dr. Carolee Dodge-Francis and Lorelei DeCora, consultants on the project (under contract to Westat).


The estimated annualized cost of this data collection to the government is $227,697, for each year of this two year project. The cost involves the labor hours for instrument development, preparation of clearance packages, travel to sites, conduct of interviews and focus groups, respondent incentives, data analysis, and reporting.


15. Explanation for Program Changes or Adjustments


This is new data collection.


16. Plans for Tabulation and Publication and Project Time Schedule


As the research and evaluation contractor, Westat will analyze interview and focus group responses, as well as observational data, across the eight communities visited. Findings will be examined to identify trends and patterns as well as differences in overall responses and patterns and differences by type of respondent. Westat will use a notes-based analysis process similar to that recommended by Krueger (1994) and Patton (2002) for the analysis of qualitative data:


  • Content analysis will involve the identification, labeling, and categorization of data. This analysis reviews records from data collection sources (notes, top line reports, observations, etc.) to identify trends across respondent categories or groups.

  • Thematic analysis will determine if certain themes emerge from patterns identified in the content analysis. These themes may be articulated directly by the participants or identified by the study team. In addition to assisting with the identification of patterns and themes in the data, content and thematic analyses also allow large amounts of collected data to be reduced or distilled into a more easily studied and understood format.

      • Logical analysis yields patterns of difference, as well as similarities that may emerge from cross-classifying the data. This step is helpful in identifying patterns or themes that are not immediately obvious, while also taking into consideration the outlier opinions.

Westat will also use text analysis software, Atlas Ti, to facilitate data analysis. Atlas Ti allows users to electronically label selected text using a set of user-defined codes or labels representing certain themes, concepts, or findings of interest. Once selected text from a transcript is coded, Atlas Ti allows users to conduct various analyses and comparisons of coded responses across or between focus group transcripts. Westat staff have received training on Atlas Ti and have used the text analysis software to analyze data from over 100 focus groups and interviews.


Westat will also develop a codebook that will be used to code the focus group and interview data (notes). To ensure the reliability and validity of the coding process, each data set will be assigned a primary coder, whose coding will be reviewed by a secondary coder. A team of two coders will serve as primary coders on half of the data sets and secondary coder on the other half.

Any discrepancies in the coding of data will be resolved using a consensus approach, with input from the Westat project director, as needed.



Activity

Time Schedule

Contract sites and begin scheduling

1 week following OMB approval

Conduct site visits

Commence within 4 to 6 weeks following OMB approval:

  • 2 site visits Fall 2011

  • 3 site visits Spring 2012

  • 2 site visits Fall 2012

  • 1 site visit Spring 2013

Analysis and reporting of findings

Commence within 1 week of return from each site visit:

  • Fall 2011

  • Spring 2012

  • Fall 2012

  • 1 site visit Spring 2013

Interim report of site visit findings

Within 3 months of completion of last site visit, for that year:

  • Winter 2011

  • Summer 2012

  • Winter 2012

  • Summer 2013)

Final report of site visit findings

Within 3 months of completion of final site visit (Spring-Summer 2013)




17. Reasons(s) Display of OMB Expiration Date is Inappropriate


Exemption is not being sought.


18. Exceptions to Certification for Paperwork Reduction Act Submission


There are no exceptions to certification.





REFERENCES



Bureau of Labor Statistics (2008). Bureau of Labor Statistics National Occupational Employment and Wage Estimates for Community and Social Service Occupations. Available at http://www.bls.gov/oes/2008/may/oes_nat.htm#b21-0000 [April 2010].


Bureau of Labor Statistics (2008). National Occupational Employment and Wage Estimates for Education, Training, and Library Occupations. 2008. Available at http://www.bls.gov/oes/2008/may/oes_nat.htm#b25-0000 [April 2010].


Bureau of Labor Statistics (2008). National Occupational Employment at Wage Estimates for Management Occupations. 2008. Available at http://www.bls.gov/oes/2008/may/oes_nat.htm#b11-0000 [April 2010].


Bureau of Labor Statistics (2010). The Employment Situation-April 2010. Available at http://www.bls.gov/news.release/pdf/empsit.pdf. [May 2010].


Centers for Disease Control and Prevention 2006). Diagnosed diabetes among American Indians and Alaska Natives Aged <35 Years --- United States, 1994—2004. Morbidity and Mortality Weekly Report, 55, 1201-1203.


Francis CD, Coulson D, Kalberer B, DeBruyn L, Freeman W, Belcourt J (2010). The significance of a K-12 diabetes-based science education program for tribal populations: evaluating cognitive learning, cultural context, and attitudinal components. Journal of Health Disparities and Research Practice. 2010; 3:91–105.


Harris, M.I. (1995). Chapter 1: Summary. In: Harris, M.I., Cowie, C.C., Stern, M.P., Boyko, E.J., Reiber, G.E., Bennett, P.H., (Eds.), Diabetes in America, 1-13.


Krueger, R.A. (1994). Focus groups: A practical guide for applied research. Thousand Oaks, CA: Sage Publications.

Patton, M. (2002). Qualitative evaluation and research methods, 3rd ed. Newbury Park: Sage Publications.

Roberts, H., Jiles, R., Mokdad, A., Beckles, G., Rios-Burrows, N. The widening gap of diabetes between American Indian/Alaska Native young adults and Non-Hispanic young adults. Ethnicity & Disease, 19, 2009.






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